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Abstract：
OBJECTIVE: In adult major trauma patients admission hypocalcaemia occurs in approximately half of cases and is associated with increased mortality. However, data amongst paediatric patients are limited. The objectives of this review were to determine the incidence of admission ionised hypocalcaemia in paediatric major trauma patients and to explore whether hypocalcaemia is associated with adverse outcomes.
METHODS: A systematic review was conducted following PRISMA guidelines. All studies including major trauma patients <18 years old, with an ionised calcium concentration obtained in the Emergency Department (ED) prior to the receipt of blood products in the ED were included. The primary outcome was incidence of ionised hypocalcaemia. Random-effects Sidik-Jonkman modelling was executed for meta-analysis of mortality and pH difference between hypo- and normocalcaemia, Odds ratio (OR) was the reporting metric for mortality. The reporting metric for the continuous variable of pH difference was Glass\' D (a standardized difference). Results are reported with 95% confidence intervals (CIs) and significance was defined as p <0.05.
RESULTS: Three retrospective cohort studies were included. Admission ionised hypocalcaemia definitions ranged from <1.00 mmol/l to <1.16 mmol/l with an overall incidence of 112/710 (15.8%). For mortality, modelling with low heterogeneity (I2 39%, Cochrane\'s Q p = 0.294) identified a non-significant (p = 0.122) estimate of hypocalcaemia increasing mortality (pooled OR 2.26, 95% CI 0.80-6.39). For the pH difference, meta-analysis supported generation of a pooled effect estimate (I2 57%, Cochrane\'s Q p = 0.100). The effect estimate of the mean pH difference was not significantly different from null (p = 0.657), with the estimated pH slightly lower in hypocalcaemia (Glass D standardized mean difference -0.08, 95% CI -0.43 to 0.27).
CONCLUSIONS: Admission ionised hypocalcaemia was present in at least one in six paediatric major trauma patients. Ionised hypocalcaemia was not identified to have a statistically significant association with mortality or pH difference.
METHODS: A systematic review was conducted following PRISMA guidelines. All studies including major trauma patients <18 years old, with an ionised calcium concentration obtained in the Emergency Department (ED) prior to the receipt of blood products in the ED were included. The primary outcome was incidence of ionised hypocalcaemia. Random-effects Sidik-Jonkman modelling was executed for meta-analysis of mortality and pH difference between hypo- and normocalcaemia, Odds ratio (OR) was the reporting metric for mortality. The reporting metric for the continuous variable of pH difference was Glass\' D (a standardized difference). Results are reported with 95% confidence intervals (CIs) and significance was defined as p <0.05.
RESULTS: Three retrospective cohort studies were included. Admission ionised hypocalcaemia definitions ranged from <1.00 mmol/l to <1.16 mmol/l with an overall incidence of 112/710 (15.8%). For mortality, modelling with low heterogeneity (I2 39%, Cochrane\'s Q p = 0.294) identified a non-significant (p = 0.122) estimate of hypocalcaemia increasing mortality (pooled OR 2.26, 95% CI 0.80-6.39). For the pH difference, meta-analysis supported generation of a pooled effect estimate (I2 57%, Cochrane\'s Q p = 0.100). The effect estimate of the mean pH difference was not significantly different from null (p = 0.657), with the estimated pH slightly lower in hypocalcaemia (Glass D standardized mean difference -0.08, 95% CI -0.43 to 0.27).
CONCLUSIONS: Admission ionised hypocalcaemia was present in at least one in six paediatric major trauma patients. Ionised hypocalcaemia was not identified to have a statistically significant association with mortality or pH difference.
摘要：
目的：在成年严重创伤患者中，约有一半病例发生低钙血症，并与死亡率增加相关。然而,儿科患者的数据有限。本综述的目的是确定儿科严重创伤患者入院电离性低钙血症的发生率，并探讨低钙血症是否与不良结局相关。
方法：按照PRISMA指南进行系统评价。所有研究包括<18岁的重大创伤患者，包括在急诊科（ED）收到血液制品之前在急诊科（ED）获得的电离钙浓度。主要结果是电离性低钙血症的发生率。随机效应Sidik-Jonkman模型用于低钙血症和正常钙血症之间的死亡率和pH差异的荟萃分析。赔率比(OR)是死亡率的报告指标。pH差异的连续变量的报告度量为Glass\'D(标准化差异)。以95%置信区间(CI)报告结果,并且显著性定义为p<0.05。
结果：纳入三项回顾性队列研究。入院电离性低钙血症定义范围为<1.00mmol/l至<1.16mmol/l，总发生率为112/710（15.8％）。对于死亡率，具有低异质性的建模(I239%，Cochrane的Qp=0.294）确定了低钙血症增加死亡率的非显著（p=0.122）估计（汇总OR2.26，95％CI0.80-6.39）。对于pH差异，荟萃分析支持汇总效应估计的产生(I257%，科克伦的Qp=0.100)。平均pH差异的效应估计与null没有显着差异（p=0.657），低钙血症的估计pH值略低（GlassD标准化平均差-0.08，95％CI-0.43至0.27）。
结论：六位儿科严重创伤患者中至少有一位存在入院电离性低钙血症。未发现电离性低钙血症与死亡率或pH差异具有统计学上的显着关联。
方法：按照PRISMA指南进行系统评价。所有研究包括<18岁的重大创伤患者，包括在急诊科（ED）收到血液制品之前在急诊科（ED）获得的电离钙浓度。主要结果是电离性低钙血症的发生率。随机效应Sidik-Jonkman模型用于低钙血症和正常钙血症之间的死亡率和pH差异的荟萃分析。赔率比(OR)是死亡率的报告指标。pH差异的连续变量的报告度量为Glass\'D(标准化差异)。以95%置信区间(CI)报告结果,并且显著性定义为p<0.05。
结果：纳入三项回顾性队列研究。入院电离性低钙血症定义范围为<1.00mmol/l至<1.16mmol/l，总发生率为112/710（15.8％）。对于死亡率，具有低异质性的建模(I239%，Cochrane的Qp=0.294）确定了低钙血症增加死亡率的非显著（p=0.122）估计（汇总OR2.26，95％CI0.80-6.39）。对于pH差异，荟萃分析支持汇总效应估计的产生(I257%，科克伦的Qp=0.100)。平均pH差异的效应估计与null没有显着差异（p=0.657），低钙血症的估计pH值略低（GlassD标准化平均差-0.08，95％CI-0.43至0.27）。
结论：六位儿科严重创伤患者中至少有一位存在入院电离性低钙血症。未发现电离性低钙血症与死亡率或pH差异具有统计学上的显着关联。
